e18627 Background: Timely radiographic studies are essential to oncology care. At our institution, a safety net hospital in a large metropolitan area, baseline assessment determined that the overwhelming majority of outpatient computed tomographic (CT) scans for oncology patients were overdue for scheduling. We applied the Lean Kaizen quality improvement model to improve on-time scheduling of CT scans in our hematology-oncology clinic. Lean Kaizen is centered around eliminating waste, improving productivity, and maintaining sustained improvement through collaborative efforts from multiple departments to analyze system workflow inefficiencies in a stepwise fashion. Methods: In collaboration with our Kaizen Promotion Office, we conducted a series of interdisciplinary meetings including staff from radiology, oncology, scheduling, and administration. All aspects of the scheduling workflow were critically reviewed and barriers to scheduling were identified using an Ishikawa root-cause diagram and the Kaizen principle of gemba (“go and see the work”). A new workflow was developed in which clinic staff scheduled patients for CT scans prior to clinic discharge. To implement the new workflow, we employed the principles of shojinka (“create flow”) and nagara (“eliminate waste”). We developed and distributed workflow guides, conducted simulation events, and provided one-on-one training to ensure a successful rollout. Three months after our initial meeting, the new workflow was launched. The workflow was refined based on feedback from daily pre-clinic team meetings. Results: Preliminary data were gathered approximately 3 weeks following implementation of our new workflow. Since our intervention, the percentage of CT scans overdue for scheduling decreased from 87% (65 of 75 CT scans) to 17% (9 of 53 CT scans). Conclusions: Our study showed that the Lean Kaizen QI model was successful in improving the rate of oncology patients scheduled for CT scans in a timely fashion. This study demonstrated the importance of interdepartmental collaboration and continuous monitoring for improvement. Given the success of this project, this workflow will be expanded to other services within our institution following the Kaizen principle of yokoten (“sharing knowledge”).
613 Background: Existing literature has reported differences in clinical outcomes by ethnicity in patients receiving immune checkpoint inhibitors (Olsen et al Front Oncol 2021). We investigated real-world outcomes between Latinx and non-Latinx mRCC patients treated with first-line nivo/ipi within a safety-net healthcare system and at a tertiary care center in Southern California. Methods: We performed a retrospective analysis of mRCC patients who received nivo/ipi within the Los Angeles County Department of Health Services (DHS), a safety-net healthcare system, and the City of Hope Comprehensive Cancer Center (COH), a tertiary oncology center, between Jan. 1, 2015 and Dec. 31, 2021. Patients were identified using institutional databases and clinical data were compiled from electronic health records. Patients with pathologic diagnosis of mRCC, age > 18 years and receipt of nivo/ipi as first-line therapy were included. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards model with adjustments for other covariates. Results: Of 94 patients, 66 (70%) were male, 90 (94%) had clear-cell histology, and 87 (93%) had IMDC intermediate/poor risk disease. Forty patients (43%) were Latinx. Fifty (53%) and 44 (47%) patients received their care at a tertiary care center and within a safety-net healthcare system, respectively. Most Latinx patients (95%) were treated at DHS, and most non-Latinx patients (89%) were treated at COH. Latinx patients were significantly older than non-Latinx patients (59.5 vs 55 years, p=0.008). IMDC risk classification, body mass index, history of nephrectomy, and number of comorbidities were similar between both groups. Pooled analysis by ethnicity demonstrated significantly shorter PFS in Latinx versus non-Latinx patients (10.1 vs 25.2 months, HR 3.61, 95% CI 1.96-6.66, p= <0.01). Adjusting for age, gender, IMDC risk classification, history of nephrectomy, and number of co-morbidities, multivariate analysis revealed a HR of 3.41 (95% CI 1.31-8.84; p=0.01). At a median follow up of 11.0 months, the median OS was not met in either arm at the time of data cutoff (NR vs. NR, HR 1.34, 95% CI 0.44-4.11). Conclusions: Compared to non-Latinx patients,Latinx patients demonstrated shorter PFS; no difference was observed in OS although these data were immature. As the majority of Latinx patients received their care at DHS, our data suggest that disparities in access to care may significantly contribute to differences in clinical outcomes of mRCC patients receiving nivo/ipi.
PURPOSE: Timely radiographic studies are essential to oncology care. At our institution, a safety net hospital in a large metropolitan area, baseline assessment determined that the overwhelming majority of outpatient computed tomographic (CT) scans for oncology patients were overdue and not scheduled within 2 weeks of their first requested date. METHODS: We conducted a series of structured, interdisciplinary meetings including staff from radiology, oncology, scheduling, and administration to critically review the scheduling process utilizing Lean Kaizen quality improvement methods. A new workflow was developed in which clinic staff scheduled CT scans before clinic discharge. Three months after our initial meeting, the new workflow was launched. We set a target of decreasing the percentage of overdue scans to below 20%. RESULTS: At baseline, 87% (65 of 75) of CT scans awaiting scheduling were overdue. Data were gathered at 5 and 10 weeks after implementation of our workflow. The percentage of CT scans overdue for scheduling was 17% (9 of 53) at 5 weeks and 0.97% (1 of 103) at 10 weeks after implementation. Clinic visit durations were not affected. CONCLUSION: The Lean Kaizen QI model was successful in decreasing the rate of oncology patients overdue for CT scan scheduling with minimal effects on clinic visit durations. This study demonstrated the importance of interdepartmental collaboration and continuous monitoring for improvement. Given the success of this project, this workflow will be expanded to other outpatient clinics within our institution.
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